Abstract:Objective To explore the application value of small bone window hematoma evacuation via the inferior Rolandic point-insular approach through the lateral fissure(i.e.,surgery via the lateral fissure approach)and traditional small bone window hematoma evacuation via the temporal lobe cortex approach(i.e.,surgery via the temporal lobe approach)in the treatment of hypertensive intracerebral hemorrhage(HICH).Methods Ninety patients with HICH were prospectively selected and randomly divided into a traditional group and a modified group,with 45 patients in each group,using a simple randomization method.The traditional group underwent surgery via the temporal lobe approach,while the modified group underwent surgery via the lateral fissure approach.The surgical conditions,postoperative recovery,cerebral oxygen metabolism indicators before and after surgery[jugular vein oxygen content(CjvO2),arterial jugular vein oxygen content difference(Da-jvO2),and arterial oxygen content(CaO2)],National Institutes of Health Stroke Scale(NIHSS)scores,Glasgow Outcome Scale(GOS)scores,and complications were compared between the two groups.Results The hematoma evacuation rate 24 hours after surgery was higher in the modified group than in the traditional group,and the depth of white matter incision and the length of hospital stay were lower in the modified group(all P<0.05).Seven days after surgery,CjvO2 was higher in the modified group than in the traditional group,while CaO2 and Da-jvO2 were lower(all P<0.05).Six months after surgery,the NIHSS score was lower and the GOS score was higher in the modified group than in the traditional group(all P<0.05).There was no statistically significant difference in the incidence of complications between the two groups(P>0.05).Conclusions Surgery via the lateral fissure approach for HICH can improve the hematoma evacuation effect,enhance cerebral oxygen metabolism,promote postoperative recovery,facilitate the restoration of neurological function,and improve prognosis.Its safety is comparable to that of surgery via the temporal lobe approach.

Abstract:Objective To evaluate the efficacy of combined extracranial-intracranial vascular bypass surgery for Moyamoya disease and the influencing factors of postoperative complications.Methods The clinical data of 291 patients(337 sides)with moyamoya disease,who underwent superficial temporal artery to middle cerebral artery(STA-MCA)anastomosis combined with encephalo-duro-arterio-synangiosis(EDAS),were analyzed retrospectively.Postoperative neurological complications were observed.Univariate and multivariate logistic regression analyses were applied to explore the influencing factors.Follow-up at 6 months postoperatively was conducted to determine the occurrence of postoperative cerebral hemorrhage or cerebral infarction.Neurological function was evaluated using the modified Rankin Scale(mRS)at 6 months postoperatively.Results Moyamoya disease surgery was successful in all the 291 patients(337 sides),with neurological complications occurring in 47(16.15%):including 36 of cerebral infarction,8 of epilepsy,and 3 of cerebral hemorrhage.Among them,6 patients experienced severe complications(postoperative cerebral infarction with an increased mRS score postoperatively).There were no perioperative deaths.Multivariate logistic regression analysis indicated that age and preoperative comorbid hypertension were risk factors for severe postoperative complications(both P<0.05).Conclusions Combined extracranial-intracranial vascular bypass surgery is a safe and effective treatment for Moyamoya disease.Postoperative cerebral infarction is a common complication,but only a small proportion of patients exhibit increased mRS scores.

Abstract:Objective To investigate the evaluative role of visinin-like protein-1(VILIP-1),heat shock protein 47(HSP47),and angiopoietin-like protein 4(ANGPTL4)in the short-term functional prognosis of elderly patients with acute cerebral infarction(ACI).Methods The clinical data of 89 elderly patients with ACI(ACI group)were analyzed retrospectively,all of whom received intravenous thrombolytic therapy.Functional prognosis was assessed using the Activities of Daily Living(ADL)scale 3 months after treatment,and patients were divided into a good functional prognosis group(ADL score>60)and a poor functional prognosis group(ADL score≤60).Additionally,89 healthy individuals undergoing physical examinations during the same period were selected as the control group.The expression levels of serological indicators(VILIP-1,HSP47,ANGPTL4)were compared between the ACI group and the control group.The correlation between these serological indicators and the degree of neurological impairment in elderly ACI patients was analyzed,along with their evaluative efficacy for poor functional prognosis.Results Before thrombolysis,the expression levels of serum VILIP-1,HSP47,and ANGPTL4 in the ACI group were higher than those in the control group(all P<0.05).Before thrombolysis,elderly patients with mild ACI had lower serum levels of VILIP-1,HSP47,and ANGPTL4 compared to those with moderate and severe ACI,while patients with moderate ACI had lower levels than those with severe ACI(all P<0.05).Spearman correlation coefficient analysis revealed that pre-thrombolysis serum VILIP-1,HSP47,and ANGPTL4 were positively correlated with the degree of neurological impairment in elderly ACI patients(all P<0.05).The proportion of patients with large-area infarction and severe neurological impairment was higher in the poor functional prognosis group than in the good functional prognosis group(both P<0.05).Three days after thrombolysis,serum VILIP-1,HSP47,and ANGPTL4 levels decreased in elderly ACI patients with different functional prognoses compared to pre-thrombolysis levels;however,the expression levels of these indicators were higher in the poor functional prognosis group than in the good functional prognosis group both before and 3 days after thrombolysis(all P<0.05).The area under the receiver operating characteristic(ROC)curve(AUC)for the combined evaluation of poor functional prognosis in elderly ACI patients using serological indicators(VILIP-1,HSP47,ANGPTL4)was 0.937(95%CI:0.864-0.978),with a sensitivity of 90.48%and a specificity of 83.58%(P<0.05).Conclusions Serum levels of VILIP-1,HSP47,and ANGPTL4 are significantly elevated in elderly patients with ACI and are correlated with the degree of neurological impairment.Combined detection of these serological indicators holds high evaluation value for the short-term functional prognosis of elderly patients with ACI.

Abstract:Objective To explore the risk factors for sleep disorders after brain injury and to establish a predictive model.Methods The clinical data of 240 patients with brain injury were analyzed retrospectively.All the patients were assessed using the Pittsburgh Sleep Quality Index(PSQI).Based on PSQI scores,patients were divided into a sleep disorder group(PSQI>7,n=129)and a non-sleep disorder group(PSQI≤7,n=111).Univariate analysis was performed to compare differences in clinical data between the two groups.Statistically significant indicators were included in logistic regression analysis to identify factors influencing the occurrence of sleep disorders after brain injury and to construct a predictive model.The predictive performance of the model was evaluated using the receiver operating characteristic(ROC)curve.Results The incidence of sleep disorders was 53.75%.Logistic regression analysis revealed that age≥50 years,severe brain injury,hemiplegia,severe pain,comorbid diabetes,higher 17-item hamilton depression rating scale(HAMD-17)scores,and higher hamilton anxiety scale(HAMA)scores were significant risk factors for sleep disorders after brain injury(all P<0.05).The Hosmer-Lemeshow test showed good calibration of the predictive model(χ2=0.289,P=0.117).ROC curve analysis demonstrated that the area under the curve(AUC)of the model for predicting sleep disorders after brain injury was 0.848(95%CI:0.763-0.934),with a sensitivity of 81.47%and specificity of 73.63%.Conclusions Multiple factors influence the occurrence of sleep disorders in patients with brain injury.The predictive model constructed based on relevant risk factors exhibits high predictive value,enabling clinicians to promptly identify patients at high risk of sleep disorders and implement appropriate interventions to improve sleep quality in patients with brain injury.

Abstract:Objective To explore the longitudinal mediating effect of autonomic dysfunction on sleep quality and living ability in patients with severe traumatic brain injury(sTBI).Methods A total of 245 sTBI patients undergoing treatment were enrolled.The Simplified Evaluation of Consciousness Disorders(SECONDs),the Chinese version of the Rapid Eye Movement Sleep Behavior Disorder Screening Questionnaire(RBDSQ),and the Quality of Life after Brain Injury(QOLIBRI)scale were administered for continuous follow-up over 6 months.Using latent variable growth curve models and longitudinal mediation models,a longitudinal analysis was conducted on the relationships between sleep quality,autonomic dysfunction,and living ability in sTBI patients,and the mediating role of autonomic dysfunction was explored.Results The correlation analysis results showed significant correlations between decreased sleep quality,autonomic dysfunction,and deteriorated living ability in sTBI patients(all P<0.05).The linear latent growth model results indicated that the living ability and autonomic function of sTBI patients showed a declining trend,while decreased sleep quality showed an increasing trend.The latent variable growth curve mediation model revealed that the total effect of the RBDSQ intercept on the QOLIBRI intercept was significant(β=3.453,P=0.006),the indirect effect of the SECONDs intercept between the RBDSQ intercept and the QOLIBRI intercept was significant(β=0.984,P=0.000),and the direct effect of the RBDSQ intercept on the QOLIBRI intercept was significant(β=0.758,P=0.002).The total effect of the RBDSQ slope on the QOLIBRI slope was not significant(β=0.023,P=0.602),the indirect effect of the SECONDs slope between the RBDSQ slope and the QOLIBRI slope was significant(β=0.456,P=0.002),and the direct effect of the RBDSQ slope on the QOLIBRI slope was not significant(β=-0.185,P=0.084).Conclusions There is a close longitudinal association between sleep quality,autonomic dysfunction,and living ability in sTBI patients.Decreased sleep quality can exacerbate the symptoms of autonomic dysfunction,thereby further reducing the patients'living ability.Early and effective intervention for autonomic dysfunction may improve the patients'living ability to a certain extent.

Abstract:Objective To compare the clinical efficacy of the microscope-assisted versus the neuroendoscope-assisted transsylvian-insular approach in the treatment of basal ganglia intracerebral hemorrhage.Methods A total of 204 patients with spontaneous basal ganglia intracerebral hemorrhage were included and randomly divided into a neuroendoscope group(n=96,undergoing neuroendoscope-assisted hematoma evacuation via transsylvian-insular approach)and a microscope group(n=108,undergoing microscopic hematoma evacuation via transsylvian-insular approach)using a random number table.The operative time,hospital stay,hematoma evacuation rate,and incidence of postoperative complications(including intracranial infection,rebleeding,cerebral infarction,epilepsy,gastrointestinal bleeding,and pulmonary infection)were compared between the two groups.Neurological function was assessed using the National Institute of Health Stroke Scale(NIHSS),consciousness state was evaluated using the Glasgow Coma Scale(GCS),and daily living ability was assessed using the Barthel Index.The overall recovery was evaluated using the Glasgow Outcome Scale(GOS)at 6 months postoperatively.Results There were no statistically significant differences in preoperative hematoma volume and time from onset to surgery between the two groups(both P>0.05).The neuroendoscope group had significantly less residual hematoma volume and a higher hematoma evacuation rate than the microscope group(both P<0.05).The operative time and hospital stay were significantly shorter in the neuroendoscope group than in the microscope group(both P<0.05).There was no statistically significant difference in the incidence of postoperative complications between the two groups(P>0.05).At 4 weeks postoperatively,the GCS score was higher and the NIHSS score was lower in the neuroendoscope group than in the microscope group (both P<0.05). At 3 months postoperatively, the Barthel Index was significantly higher in the neuroendoscope group than in the microscope group (P<0.05). There was no statistically significant difference in the good outcome rate based on the GOS score at 6 months postoperatively between the two groups (P>0.05). Conclusions Neuroendoscope-assisted hematoma evacuation via transsylvian-insular approach can more effectively evacuate hematomas, achieve precise hemostasis, reduce postoperative cerebral edema, and improve short-term neurological function and daily living ability in patients. However, it shows no significant advantage over microscope-assisted surgery in improving long-term prognosis at 6 months postoperatively.

Abstract:Objective To explore the clinical value of intracranial pressure(ICP)monitoring in the treatment of severe traumatic brain injury(sTBI)in plateau area.Methods The clinical data of 102 patients with sTBI in plateau area were analyzed retrospectively.Based on whether ICP monitoring was performed,the patients were divided into a monitoring group(n=51)and a control group(n=51).The prognostic outcomes of the two groups were compared,along with the relationship between ICP data and prognosis in the monitoring group.Results The favorable prognosis rate was 64.7%in the monitoring group and 54.9%in the control group,with the monitoring group demonstrating a superior prognosis compared to the control group,showing a statistically significant difference(P<0.05).According to the Glasgow Outcome Scale(GOS)score at 3 months postoperatively,patients in the monitoring group were categorized into a poor prognosis group(GOS≤3,n=18)and a favorable prognosis group(GOS≥4,n=33).The average ICP in the poor prognosis group was higher than that in the favorable prognosis group,while the average cerebral perfusion pressure(CPP)was lower,with both differences being statistically significant(both P<0.001).Conclusions sTBI in plateau area is characterized by acute onset,severe illness,and rapid changes.Real-time ICP monitoring holds significant value in guiding treatment plans and assessing prognosis.Early diagnosis and active surgical intervention can markedly improve patient prognosis.

Abstract:Objective To analyze the improvement effects of bilateral sequential repetitive transcranial magnetic stimulation(rTMS)on motor and cognitive functions in secondary brain injury following high-altitude traumatic brain injury(TBI).Methods A total of 82 patients with secondary brain injury after high-altitude TBI were selected and randomly divided into a conventional group(41 patients receiving conventional treatment)and an intervention group(41 patients receiving bilateral sequential rTMS treatment in addition to conventional treatment)using a random number table method.Neurotrophic factors,serological indicators,cognitive function,motor function,activities of daily living(ADL),and adverse reactions were compared between the two groups.Results There was no statistically significant difference in baseline data between the two groups(all P>0.05),indicating comparability.At 3 months post-intervention,insulin-like growth factor(IGF-1)and brain-derived neurotrophic factor(BDNF)levels increased significantly in both groups compared to pre-intervention levels,with the intervention group showing significantly higher levels than the conventional group(both P<0.05).In contrast,lactate dehydrogenase(LDH)and aquaporin-1(AQP-1)levels decreased in both groups compared to pre-intervention levels,with lower levels in the intervention group(both P<0.05).At 3 and 6 months after intervention,the mini-mental state examination(MMSE)scores,upper limb motor function scores,lower limb motor function scores,and ADL scores were higher in both groups compared to pre-intervention levels,with greater improvements in the intervention group(all P<0.05).No serious adverse reactions were reported,except for one patient in the intervention group experienced mild transient temporal pain,which resolved spontaneously without recurrence.Conclusions Early intensive rehabilitation training combined with bilateral sequential rTMS can modulate neurotrophic factors and serological indicators,improve motor function and cognitive functions,and enhance ADL in patients with high-altitude TBI,demonstrating a favorable safety profile.

Abstract:Objective To investigate the efficacy and safety of ventriculoperitoneal shunt(VPS)and lumboperitoneal shunt(LPS)in the treatment of patients with normal-pressure hydrocephalus(NPH).Methods A search was conducted across PubMed,Medline,The Cochrane Library,Web of Science,Embase,Ovid Cochrane Central Register of Controlled Trials,Wanfang Medical Network,China National Knowledge Infrastructure(CNKI),and VIP Chinese Science and Technology Journal Database to screen research literature on the treatment of NPH with VPS and LPS,with the publication date of the retrieved literature up to December 31,2024.Review Manager 5.4 software was used for meta-analysis.Results A total of eight studies involving 1,680 patients were included.The meta-analysis revealed the following:(1)The overall efficacy did not differ significantly between the VPS and LPS groups[odds ratio(OR)=1.13,95%confidence interval(CI):0.71-1.80,P>0.05].(2)The VPS group had a significantly higher risk of postoperative infection than the LPS group(OR=2.76,95%CI:1.31-5.82,P<0.05).(3)No significant intergroup differences were observed for other postoperative complications,including intracranial hemorrhage(OR=1.16,95%CI:0.69-1.96),shunt malfunction(OR=0.95,95%CI:0.57-1.59),and shunt dysfunction(OR=0.39,95%CI:0.09-1.66)(all P>0.05).Conclusions There is no significant difference in surgical efficacy between the VPS and LPS groups,while the LPS group exhibits a lower overall incidence of postoperative complications.

Abstract:Brain-computer interface(BCI)serves as a bridge connecting the brain to external devices,demonstrating significant advancements in functional neurosurgery.Currently,BCI technology is extensively utilized for motor function reconstruction,neuromodulation,and the treatment of neurological and psychiatric disorders.Nevertheless,existing systems continue to face substantial challenges in decoding accuracy,long-term stability,and adaptability.The introduction of personalized brain-computer interface(PBCI),through the integration of multimodal data and artificial intelligence technologies,has markedly enhanced the precision and adaptability of BCI systems.This review comprehensively summarizes the fundamental concepts,key technologies,and application potential of PBCI in functional neurosurgery.Firstly,it elaborates on the theoretical foundations and structural components of PBCI from the perspective of personalized medicine,emphasizing the critical role of integrating brain imaging,genomic,and behavioral data in optimizing signal decoding and treatment strategies.Secondly,it focuses on technological innovations of PBCI in the integration of BCI with deep brain stimulation(BCI-DBS),multimodal imaging analysis,and artificial intelligence fusion.This section clarifies the principles and methodologies for achieving personalized neuromodulation,and discuss its practical applications in treating such conditions as Parkinson's disease,epilepsy,and obsessive-compulsive disorder(OCD).Finally,the review sums up clinical application cases and prospects of PBCI in managing Parkinson's disease and epilepsy,outlines current technical challenges in PBCI development,and envisions future directions in closed-loop regulation,neural network analysis,and personalized medicine.By advancing personalized brain-computer interfaces,functional neurosurgery holds promise for delivering more precise and efficient neuromodulation therapies,thereby offering new therapeutic horizons for patients with neurological disorders.

Abstract:Objective To investigate the clinical efficacy of contact neuroendoscopic hematoma evacuation in hypertensive intracerebral hemorrhage(HICH).Methods The clinical data of 100 surgical patients with HICH were analyzed retrospectively,who were divided into a traditional surgery group(n=50,treated with craniotomy for hematoma evacuation)and a neuroendoscopic group(n=50,treated with contact neuroendoscopic-controlled hematoma evacuation).Perioperative indicators,biochemical markers,neurological function,activities of daily living,prognosis,and postoperative complications were compared between the two groups.Results The neuroendoscopic group had shorter operation time,shorter hospital stay,and less intraoperative blood loss compared to the traditional surgery group,with a higher hematoma evacuation rate.The differences were statistically significant(all P<0.05).Before surgery,there were no significant differences in tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),and neuron-specific enolase(NSE)levels between the two groups(all P>0.05).After treatment,TNF-α and CRP levels increased,while NSE levels decreased in both groups,with the traditional surgery group showing higher levels of TNF-α,CRP,and NSE than the neuroendoscopic group(all P<0.05).Before surgery,there were no significant differences in National Institutes of Health Stroke Scale(NIHSS)and Barthel Index(BI)scores between the two groups(all P>0.05).After treatment,NIHSS scores decreased,and BI scores increased in both groups,with the neuroendoscopic group having lower NIHSS scores and higher BI and Glasgow Outcome Scale(GOS)scores than the traditional surgery group.The differences were statistically significant(all P<0.05).The incidence of postoperative complications in the neuroendoscopic group(2.00%)was lower than that in the traditional surgery group(16.00%),with a statistically significant difference between the groups(P<0.05).Conclusions The treatment of HICH via contact neuroendoscopic hematoma evacuation demonstrates advantages including minimal invasiveness,favorable prognosis,and fewer complications.This approach is safe and effective,embodying the dual advantages of minimally invasive and precise therapy in terms of trauma control and functional recovery for patients.

Abstract:Objective To compare the efficacy of early microsurgical clipping and endovascular embolization in the treatment of ruptured intracranial aneurysms at different locations in the anterior circulation.Methods The clinical data of 280 patients with ruptured anterior circulation aneurysms were analyzed retrospectively.Based on the treatment plan,the patients were divided into a clipping group(treated with microsurgical clipping,n=142)and an embolization group(treated with endovascular embolization,n=138).The propensity score matching(PSM)was performed with a caliper value of 0.25 and a 1:1 matching ratio,120 pairs of patients with comparable baseline data were selected.Baseline data,perioperative indicators,complications,and prognosis were compared between the two groups.Stratified analysis was then performed on statistically significant indicators according to aneurysm location:anterior communicating artery,posterior communicating artery,and middle cerebral artery.Results The clipping group had longer operation times,greater intraoperative blood loss,and longer hospital stays for aneurysms in the anterior communicating artery,posterior communicating artery,and middle cerebral artery compared to the embolization group,with statistically significant differences(all P<0.001).There was no statistically significant difference in complications between the clipping and embolization groups(P>0.05).The residual rates of aneurysmal neck at one year postoperatively were 7.50%and 47.50%in the clipping and embolization groups,respectively,with rates of 2.50%and 15.00%for anterior communicating artery aneurysms,2.50%and 15.00%for posterior communicating artery aneurysms,and 2.50%and 17.50%for middle cerebral artery aneurysms,respectively,all showing statistically significant differences(all P<0.05).The rates of good prognosis at one year postoperatively were 82.50%and 90.00%in the clipping and embolization groups,respectively,with no statistically significant difference(P>0.05).The aneurysm recurrence rates at one year postoperatively were 6.25%(3/48)and 26.67%(12/45)for anterior communicating artery aneurysms,7.14%(3/42)and 26.67%(12/45)for posterior communicating artery aneurysms,and 0.00%(0/30)and 30.00%(9/30)for middle cerebral artery aneurysms in the two groups,respectively,with no statistically significant differences(all P>0.05).Conclusions For anterior circulation ruptured intracranial aneurysms at different locations,microsurgical clipping can reduce the rate of aneurysm neck residue and is associated with a lower recurrence rate,while endovascular embolization facilitates faster patient recovery(with superior perioperative indicators).Both surgical approaches can effectively improve patient prognosis.

Abstract:Objective To investigate the predictive value of combined serological indicator detection for the risk of secondary cerebral infarction in patients with transient ischemic attack(TIA).Methods The clinical data of 90 patients with TIA were analyzed retrospectively,who were divided into a cerebral infarction group(n=32)and a non-cerebral infarction group(n=58)based on the occurrence of cerebral infarction within 90 days after TIA.Clinical data and serological indicators,including interleukin-33(IL-33),lipoprotein-associated phospholipase A2(Lp-PLA2),and chemokine-like factor 1(CKLF1)expressions,were collected in both groups.Pearson correlation analysis was performed to assess the relationships between serological indicator expressions and the National Institutes of Health Stroke Scale(NIHSS)score as well as the ABCD3-I score.Receiver operating characteristic(ROC)curves and the area under the curve(AUC)were used to analyze the single and combined predictive values of serological indicators for the risk of secondary cerebral infarction after TIA.Relative risk(RR)analysis was employed to evaluate the impact of different serological marker expressions on the occurrence of secondary cerebral infarction after TIA.Results The NIHSS score,ABCD3-I score,and serum expressions of IL-33,Lp-PLA2,and CKLF1 were significantly higher in the cerebral infarction group than in the non-cerebral infarction group(all P<0.05).In patients with secondary cerebral infarction after TIA,serum expressions of IL-33,Lp-PLA2,and CKLF1 were positively correlated with the NIHSS score and ABCD3-I score.The combined prediction of secondary cerebral infarction after TIA using serum IL-33,Lp-PLA2,and CKLF1 yielded an AUC of 0.921,which was higher than the predictive values of single markers or pairwise combinations.The risk of secondary cerebral infarction in TIA patients with high expressions of IL-33,Lp-PLA2,and CKLF1 was 8.750,15.682,and 6.171 times higher,respectively,than that in patients with low expressions.Conclusions Serum expressions of IL-33,Lp-PLA2,and CKLF1 are positively correlated with NIHSS and ABCD3-I scores.Combined detection of the three indicators can serve as an important predictive scheme for secondary cerebral infarction after TIA,assisting clinicians in selecting precise treatment plans and promoting favorable disease outcomes.

Abstract:With the intensifying trend of population aging in China,the incidence of traumatic brain injury(TBI)among older adults has been rising year by year.Falls and traffic accidents constitute the leading causes of TBI in this population.Due to age-related physiological decline,elderly patients are prone to delayed neurological deterioration following injury.Furthermore,the frequent pre-operative use of multiple medications—particularly those with anticoagulant effects—can significantly influence clinical outcomes.TBI in the elderly exhibits distinctive characteristics compared with TBI in younger adults.This review summarizes the epidemiology,etiological factors,pathophysiological features,impact of anticoagulant therapy,and current treatment strategies for TBI in the elderly.

Abstract:Objective To investigate the clinical characteristics,microsurgical treatment strategies,and clinical outcomes of spinal dural arteriovenous fistula(sDAVF).Methods The clinical data of 12 patients with sDAVF were analyzed retrospectively.The cohort included 9 males and 3 females,aged 33-75 years(median age 68 years).Among them,8 patients presented with subarachnoid hemorrhage,and 4 exhibited spinal cord dysfunction.All patients underwent digital subtraction angiography(DSA),revealing lesions on the left side in 3 cases and on the right side in 9,located at the craniocervical junction region in 8,and within the thoracolumbar spinal canal in 4.All cases were treated using a posterior median hemilaminectomy approach.Results All 12 sDAVF patients showed significant symptomatic improvement after treatment.DSA or MRI follow-up indicated the disappearance of the fistula or spinal cord vascular flow voids,meeting the criteria for clinical cure.Among them,10 patients(including 7 with lesions at the craniocervical junction)had no residual neurological deficits.One patient,who was in a moderate coma preoperatively,remained in a twilight state one year postoperatively and was unable to care for themselves,with a Karnofsky Performance Status(KPS)score of 40.Another patient had residual right lower limb muscle strength of grade V-and unstable gait one year after surgery.Conclusions Microsurgical treatment of sDAVF via a hemilaminectomy approach is safe,reliable,minimally invasive,and yields favorable therapeutic outcomes.

Abstract:Objective To investigate the risk factors for acute lower extremity deep vein thrombosis(ALDVT)in patients with spontaneous intracerebral hemorrhage(ICH).Methods The clinical data of 256 patients with spontaneous ICH were analyzed retrospectively,including etiology of hemorrhage,Glasgow Coma Scale(GCS)score,comorbid hypertension,diabetes mellitus,pulmonary infection,surgical treatment,history of limb venous thrombosis,newly developed ALDVT,affected limb muscle strength,D-dimer,blood glucose,fibrin degradation products(FDP),and ultrasound diagnostic results.Patients were divided into an ALDVT group and a non-ALDVT group based on the occurrence of new ALDVT.The incidence of ALDVT was calculated,and the treatment and prognosis after ALDVT occurrence were statistically analyzed.Univariate and multivariate logistic regression analyses were performed to explore potential risk factors for ALDVT.A nomogram prediction model was established,and its calibration performance was evaluated.Results Among the 256 patients with spontaneous ICH,aged 19-84 years(143 males and 113 females),the hospital stay ranged from 6 to 60 days.Abnormally elevated D-dimer levels were observed in 191 cases,and elevated FDP were noted in 187 cases.New ALDVT occurred in 82 cases(ALDVT group),with an incidence rate of 32.03％(82/256);174 cases were in the non-ALDVT group.In the ALDVT group,muscle strength in the affected limb was classified as grade 0 in 43 cases,grade Ⅰ in 16,grade Ⅱ in 12,grade Ⅲ in 8,grade Ⅳ in 2,and grade Ⅴ in 1.Multifactorial logistic regression analyses revealed that a GCS score≤8,comorbid diabetes,comorbid pulmonary infection,craniotomy surgery,history of venous thrombosis,muscle strength≤grade Ⅱ,and blood glucose≥10 mmol/L were risk factors for ALDVT(all P<0.05).Among the 82 ALDVT patients,63 received conservative drug treatment,17 underwent filter implantation surgery,and 2 received no treatment.Sixty-four patients experienced thrombus resolution and were discharged with improvement,resulting in a treatment effectiveness rate of 78.05％(64/82).Six patients had long-term lower extremity thrombosis,and 12 died(including 4 from pulmonary embolism).Based on the identified risk factors,a nomogram prediction model was constructed.The area under the curve(AUC)of the prediction model was 0.894(95％CI:0.848-0.933),indicating good predictive accuracy.The model also demonstrated high calibration(mean absolute error=0.005,C-index=0.897,Hosmer-Lemeshow P=0.73)and clinical utility.Conclusions Early monitoring of lower extremity venous ultrasound,D-dimer levels,and coagulation-related indicators in patients with spontaneous ICH,along with early active individualized intervention and enhanced nursing measures,can lead to favorable clinical outcomes for patients with ALDVT.

Abstract:Objective To analyze the effects of minimally invasive surgery and craniotomy on the prognosis of elderly patients with hypertensive intracerebral hemorrhage(HICH).Methods A total of 83 elderly HICH patients were selected as the study subjects and randomly divided into two groups:the minimally invasive group(42 cases,treated with small bone window minimally invasive surgery)and the craniotomy group(41 cases,treated with small bone window craniotomy).The clinical efficacy,perioperative indicators,serum factor levels,neurological function,quality of life,and postoperative adverse reactions were compared between the two groups.Results The total response rate in the minimally invasive group(92.86%)was significantly higher than that in the craniotomy group(73.17%)(P<0.05).The operative time,intraoperative blood loss,and hospital stay in the minimally invasive group were significantly lower than those in the craniotomy group,while the hematoma evacuation rate was significantly higher(all P<0.05).One month postoperatively,the levels of neuron-specific enolase(NSE),S100 calcium-binding protein β(S100-β),and heat shock protein 47(HSP47)in the minimally invasive group were significantly lower than those in the craniotomy group,while the Adropin protein level was significantly higher(all P<0.05).The National Institutes of Health Stroke Scale(NIHSS)and modified Rankin Scale(mRS)scores in the minimally invasive group were significantly lower than those in the craniotomy group one month postoperatively,while the 36-item Short-Form Health Survey(SF-36)and Functional Independence Measure(FIM)scores were significantly higher(all P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions Small bone window minimally invasive surgery can reduce brain tissue damage,improve serum protein levels,and demonstrate favorable clinical efficacy and acceptable safety in elderly HICH patients.It has a positive effect on protecting patients'neurological function.

Abstract:Objective To investigate the expression of serum heparin-binding protein(HBP),Nod-like receptor heat protein domain-related protein 3(NLRP3),and peptide in patients with postoperative pulmonary infection following hypertensive intracerebral hemorrhage(HICH)and their relationship with prognosis.Methods Clinical data of 128 HICH patients who underwent surgical treatment were analyzed retrospectively.Patients were divided into an infected group(n=31)and a non-infected group(n=97)based on the presence or absence of postoperative pulmonary infection.The changes in serum levels of HBP,NLRP3,and peptide were analyzed in the two groups.According to the Glasgow Outcome Scale(GOS)score,patients were further divided into the good prognosis group(GOS≥4 points,n=113)and the poor prognosis group(GOS≤3 points,n=15).The relationship between the aforementioned indicators and prognosis was analyzed.Results Serum levels of HBP,NLRP3,and peptide were significantly higher in the infected group than in the non-infected group,with statistically significant differences(all P<0.001).Patients in the poor prognosis group had significantly higher serum levels of HBP,NLRP3,and peptide than those in the good prognosis group(all P<0.001).Univariate screening and multivariate analysis revealed that factors associated with poor prognosis included Glasgow Coma Scale(GCS)score,HBP,NLRP3,and peptide(all P<0.1).After adjusting for confounding factors,the odds ratios(ORs)for poor prognosis associated with the three serum indicators were as follows:HBP:0.671(95%CI:0.484-0.930,P=0.017),NLRP3:1.210(95%CI:1.072-1.367,P=0.002),and peptide:3.407(95%CI:1.474-7.876,P=0.004).The areas under the receiver operating characteristic(ROC)curve(AUC)for predicting poor prognosis were 0.870(95%CI:0.805-0.936)for HBP,0.886(95%CI:0.762-1.000)for NLRP3,and 0.886(95%CI:0.814-0.959)for peptide.Conclusions Serum levels of HBP,NLRP3,and peptide are higher in HICH patients with postoperative pulmonary infection compared to those without infection.These three serological markers demonstrate good predictive ability for poor prognosis in HICH patients after surgery and may serve as effective biomarkers for predicting adverse outcomes.

Abstract:Objective To investigate the relationship between cerebrospinal fluid(CSF)levels of serum amyloid protein A1(SAA1),CXC chemokine ligand 10(CXCL10)and P38 protein and both intracranial infection and prognosis in patients with traumatic brain injury(TBI).Methods Clinical data of 70 TBI patients who developed intracranial infection after surgery(infection group)were analyzed retrospectively.Another 90 TBI patients who underwent surgical treatment during the same period without developing intracranial infection were selected as the control group.The CSF levels of SAA1,CXCL10 and P38 protein were compared between the two groups.The diagnostic value of these three indicators for intracranial infection was analyzed using the receiver operating characteristic(ROC)curve.Based on the Glasgow Outcome Scale(GOS)score at three months post-treatment,patients in the infection group were divided into a good prognosis group(GOS≥4 points,n=44)and an poor prognosis group(GOS≤3 points,n=26).A multivariate logistic regression model was used to analyze the risk factors for poor prognosis in TBI patients with postoperative intracranial infection.Results The CSF levels of SAA1 and CXCL10 were higher in the infection group than in the control group,while P38 protein levels was lower,with all differences being statistically significant(all P<0.05).The area under the curve(AUC)values for SAA1,CXCL10,P38 protein,and their combined application in diagnosing postoperative intracranial infection in TBI patients were 0.759,0.827,0.640,and 0.921,respectively.The CSF levels of SAA1 and CXCL10 were higher in the poor prognosis group than in the good prognosis group,while P38 protein levels were lower,with all differences being statistically significant(all P<0.05).The proportion of patients with an operation time≥2 h and the proportion of patients with open cranial injuries were higher in the poor prognosis group than in the good prognosis group,while GCS scores and serum albumin levels were lower,with all differences being statistically significant(all P<0.05).The GCS score at admission,serum albumin level,and CSF P38 protein level were protective factors for the prognosis of TBI patients with intracranial infection(all P<0.05),while open cranial trauma,CSF SAA1,and CXCL10 were risk factors for poor prognosis(all P<0.05).Conclusions Elevated CSF levels of SAA1 and CXCL10,compared to decreased P38 protein levels,exhibit higher diagnostic value for postoperative intracranial infection in TBI patients.Elevated CSF levels of SAA1 and CXCL10 and decreased P38 protein levels are also associated with a poor prognosis in TBI patients with intracranial infection.

Abstract:Objective To investigate the clinical efficacy of YL-1 intracranial hematoma puncture combined with bioenzymatic liquefaction(hereinafter referred to as minimally invasive puncture)in treating hypertensive intracerebral hemorrhage(HICH).Methods A prospective,single-blind,controlled design was employed,involving 300 HICH patients who were randomly divided into a craniotomy drainage group(n=150,undergoing craniotomy hematoma drainage)and a minimally invasive puncture group(n=150,undergoing minimally invasive puncture)according to a random number table.The hematoma evacuation rate,surgery-related indicators,serum oxidative stress indicators,including 8-hydroxy-2'-deoxyguanosine(8-OHdG),myeloperoxidase(MPO),and malondialdehyde(MDA)before surgery and on postoperative days 3 and 7,neurological function scores[assessed using the National Institutes of Health Stroke Scale(NIHSS)],prognosis[evaluated using the Glasgow Outcome Scale(GOS)],and complication rates were compared between the two groups.Results The minimally invasive puncture group exhibited a higher hematoma evacuation rate and superior intraoperative blood loss,surgical duration,incision length,and hospital stay compared to the craniotomy drainage group(all P<0.05).On postoperative days 3 and 7,serum levels of 8-OHdG,MPO,and MDA were lower in the minimally invasive puncture group than in the craniotomy drainage group(all P<0.05).At 3 months postoperatively,the minimally invasive puncture group showed better GOS and NIHSS scores compared to the craniotomy drainage group(both P<0.05).The overall complication rate was lower in the minimally invasive puncture group than in the craniotomy drainage group(P<0.05).Conclusions Minimally invasive puncture for HICH patients optimizes the surgical process,enhances hematoma evacuation,reduces oxidative stress and neurological damage,lowers the risk of complications,and improves patient prognosis.